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Attachment H <br /> 1 tlo R $ar mg <br /> a <br /> D' b ' e p on; lAgi �.� <br /> ., f? a xcl" foil ' Stir <br /> Contractor Covered Transactions <br /> (1 ) The prospective contractor of the Recipient, Indian River County, certifies, by submission of this <br /> document, that neither it nor its principals is presently debarred, suspended, proposed for <br /> debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any <br /> Federal department or agency. <br /> (2) Where the Recipient's contractor is unable to certify to the above statement, the prospective <br /> contractor shall attach an explanation to this form. <br /> Indian River County <br /> Contractor's Name and Title Recipient's Name <br /> 06DB-3C-10-40-01 -W 14 <br /> Signature DCA Contract Number <br /> Firm <br /> Street Address <br /> City, State, Zip <br /> Date <br /> NOTE: SUBMISSION OF THIS. FORM DOES NOT PRECLUDE RECIPIENT'S COMPLETION AND <br /> SUBMISSION OF THE "BIDDING INFORMATION AND CONTRACTOR ELIGIBILITY FORM." <br /> i <br /> 33 <br /> I <br />